The document summarizes a presentation given by a pharmacist at Taipei Medical University Hospital on finding evidence-based answers in clinical practice. It discusses using Micromedex to look up drug information like adverse effects, FDA/non-FDA uses, pharmacokinetics, comparative efficacy, and drug interactions. It provides examples of answering clinical questions for MRSA treatment and comparing vancomycin and teicoplanin. It also demonstrates how to check for drug interactions using the mobile Micromedex and addresses other clinical questions.
4. Outline
Find an evidence-based answer
FDA & Non-FDA Uses
Pharmacodynamics & Pharmacokinetics
Comparative Efficacy
Place In Therapy
Interpret drug Interactions
mobile Micromedex®
Discussion
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5. What we’ve known….
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Case-oriented
user experiences
Clinical pharmacists
General pharmacists
Drug information
藥師周刊記者
Integrate Micromedex®
into clinical decision
supporting system (CDSS)
Formulary
Drug interaction detecting
system
IV Compatibility
information
6. Case 1
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65歲男性,懷疑因MRSA造成腦膜炎而住院,病
人過去住院有vancomycin過敏紀錄(skin rash)。
醫師詢問:對vancomycin過敏的病人是否可以改
用teicoplanin進行治療?
Adverse Effects
Teicoplanin是否可用來治療MRSA造成的腦膜炎?
FDA uses/Non-FDA uses
Pharmacokinetics/Pharmacodynamics
Search in Full Document
* MRSA: methicillin-resistant Staphylococcus aeruginosa
11. Drug Interactions
User friendly
Index by drug name / brand name
Various contents
– Food, – Tobacco, – Ethanol,
– Lab, – Allergy, – Pregnancy, – Lactation
Evidence-based drug interaction
Illustrated by icons
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15. Drug Interactions
Variable results within Micromedex® database
Warfarin – Benzbromarone
Warfarin – Cefmetazole
Variable results between different databases
Thyroxin – Digoxin
Thyroxin – Theophylline
Cyclosporine – Warfarin
Variable degrees between different databases
Warfarin – Valproic acid : different significance level
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16. Discrepancies between database
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Evidence-based interactions
More applicable in clinical setting
With stronger evidence level & more clinical
significance
Pharmacokinetics- & pharmacodynamics-
proposed interactions
Class effects warrant close monitoring
Especially not yet American-approved medications
Exploring under-reporting interactions
20. Other Clinical Questions
Drug dosing in extremes of body weight
Drug Dosing in Extremes of Body Weight (UKCPA)
Medication Dosing Guidelines in Obese Adults
(RQHR)
Quick index of drug-disease interaction
Myasthenia gravis (MG)
Glucose-6-phosphate dehydrogenase defect (G-6PD)
Discrepancy of American references with other
nations’
Infusion rate of fluconazole (Diflucan®)
Infusion rate of albumin 20% “國血製劑益康”
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Comparative efficacy可以提供不同藥品間的效果比較,我們可以了解藥品在不同適應症下的優缺點。身為藥師,如何選擇一個最適合目前病人狀況的藥品是很重要的。Place in therapy則可以提供我們了解藥品在整體治療上的地位。某些藥品的place in therapy甚至會有這個藥品是否應存在於處方集的說明,以提供醫療單位作為進藥與否的參考。